Expanding Hospitalist and Senior Care Services Through Telemedicine, Clinician Support

Avel eCare CEO Doug Duskin discusses how its recent acquisition of Fident Health will help expand hospitalist and senior care telemedicine services, addressing the growing demand for care in rural areas and providing a unique clinician-to-clinician service to support health care providers. 

Tell us about yourself.

I'm Doug Duskin, chief executive officer for Avel eCare. I took this responsibility and role when Aquiline Capital Partners, our ownership group out of New York, bought the company in November of '21 from Avera Health System, which had founded this business 30 years ago. This is our 30th anniversary and while many people don't think telemedicine existed 30 years ago, it did. An exciting aspect of Avel is that it was a pioneer in the telemedicine field.  

I came to Aquiline and Avel from Equality Health, which was a value-based care technology and MSO organization where I ran their technology business. Before that, I worked with Change Healthcare and one of its predecessor organizations through multiple acquisitions. I was responsible for overseeing the government business for quality analytics and risk adjustment for Medicare and Medicaid. I have worked in health care since 2010 though I have not necessarily had the typical career expected of health care roles since I have a background in business instead of being a clinician. I like to surround myself with excellent clinicians to make sure a focus on quality delivery is always present.  

Please share how Avel eCare's recent acquisition of Fident Health will help expand hospitalist and senior care telemedicine services. 

In Avel's history, a lot of what we've done has been driven by 2 main catalysts. The first catalyst was seeking to prioritize meeting the company’s needs over the years. Our products and our services were always focused on servicing the needs of our parent company at the time, Avera Health System.  

In the early stages of the Avel lifecycle with the Helmsley Foundation, we had rural health care grants to provide services. Thus, the second catalyst was that many of our services were driven to meet those entities' needs due to the service structure in hospitalists and senior care. This dynamic has shifted over time as the market has continued to evolve and as needs increased over the pandemic.  

A significant difference highlighted by this acquisition is that we are a pure nocturnist organization, we work 24/7. Also, this is a merging of 2 different mentalities when it comes to delivering care. Merging these differences allows us to be more flexible. Additionally, there were services Fident was responsible for such as rounding, discharge, and admin work that we don’t have experience within our current practice. Pulling these businesses together will help us to offer a more holistic product.  

This acquisition has allowed us to expand our operations in many states around the southeastern US and the Mid-Atlantic where Fident was present. It is easier to sell other lines of business to a pre-existing customer base.  

Fident also has 37 excellent clinicians included in the acquisition which will be a vital network as we continue to scale our business. Relying on this network allows us more flexibility, a better relationship with our clinical staff, and ultimately a higher quality of service to our customers. 

What are the main causes of a growing demand for hospitalist and senior care support?  

The number of nurses, doctors, and medical students has decreased overall significantly over the past 3 to 4 years across the country. Rural areas struggle more than metropolitan areas with larger tertiary centers and staffing flexibility. Medical professionals in training often wish to pursue more exciting and lucrative care specialties. The US senior care population is also a growing demographic in need of increasing care and the care model has also shifted significantly. Thirty years ago, a lot of senior care services were provided by family members at home. That's not as accessible any longer for many reasons such as family members living in different communities. And quite honestly, most people aren't trained to provide the type of senior care necessary.  

Why are rural areas more affected by this shortage of care?  

Avera Health System was focused on rural communities from the beginning, and it is ingrained in our mission and culture. As we continue to provide care across the country, we must not forget rural America. That is where our bread and butter is, and we want to continue to increase and serve those communities.  

Hospitals and access to health care really keep residents in rural communities. If people can't get care or aren’t close to a hospital, people may move in search of larger communities. Health care should be as accessible in rural markets as anywhere else because it is the lifeblood of communities. 

When graduates from medical school or nursing school are choosing an area to practice in, they often need to make economic-driven decisions to pay back student debt. Large metropolitan areas may have more job opportunities and resources. In a rural community hospital, a provider may end up being the only doctor or nurse on staff sometimes. And then how are you going to take vacations? How are you going to manage your family life and other responsibilities? Sometimes providers who grew up in rural communities will return after a few years, but there is a lack of care in the meantime.  

One of the main benefits of telemedicine is how it allows us to work through the barrier of distance and provides an avenue for smaller critical access hospitals and community hospitals to stay vital within their rural communities. 

Avel eCare was one of the first telemedicine care providers to offer clinician-to-clinician services. Could you expand on how this is a unique service compared to other care providers? 

As our company expanded to ER and EMS, behavioral health, pharmacy, hospitalist, and more we kept finding that doctors need a staff augmentation. They need second opinions; somebody they can bounce ideas off that they can trust. We're not there to override them or watch over their diagnoses and treatment paths, we’re there to help be a second set of hands and eyes. This has been a vital part of what we do.  

This service means that hospitals and clinicians are our customers whereas many other organizations in the market work directly with patients. This also means they file their claim and manage the payer on behalf of patients. We don't do that as part of our business. Instead, we assign our billing to the hospital and patients remain on their census. This workflow allows the money to stay in the hospital system and allows them to continue as a vital part of their community. We don't want to compete with our customers for patients, we want to help our customers be successful and maintain their community. This way patients also don’t have to transfer hours away for medical services away from family support.  

Is there anything else you would like to add that we have not discussed? 

Telemedicine is an extremely important delivery mechanism for the health care ecosystem, whether it be in the ambulance or health care at home. Across the spectrum of care, I think our country has become more accepting and understanding of the part that telemedicine can play. Through the advancement of our technology platform and our captive network, we're allowed to serve our mission of providing health care at a high level of quality and delivery to people no matter where in the country they're located. I am excited to see how telemedicine continues to evolve and hopefully, our goal is not only to see how it evolves but to help shape it into a catalyst for providing care. The Fident acquisition was our second this year, and hopefully the second in a long chain of acquisitions as we continue to add geographies and competencies to our client offering.